SSRIs considered to have the best safety profile in the elderly are citalopram, escitalopram, and sertraline.
Tricyclic antidepressants: If an elderly individual is using a tricyclic antidepressant, they need to be used with precaution due to their side effects. Various tricyclics that appear to be effective for old people include: nortriptyline, amitriptyline, clomipramine, and desipramine. These seem to be the best tolerated tricyclics.
When it comes to antidepressants for seniors , most experts recommend SSRIs or selective norepinephrine reuptake inhibitors (SNRIs), which help increase the brain chemicals serotonin and norepinephrine. These drugs tend to have fewer serious side effects and drug interactions than older antidepressants on the market.
Tricyclic antidepressants , especially amitriptyline and dothiepin ,16 are known to pose a high risk of death in overdosage. These drugs should therefore be avoided in older people whose medication is not supervised and who are at risk of taking an overdose.
Selective serotonin reuptake inhibitors ( SSRIs ). These medications generally cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants are.
Sertraline is generally well tolerated in elderly patients with major depressive disorder and lacks the marked anticholinergic effects that characterise the adverse event profiles of tricyclic antidepressants (TCAs).
New research links certain medications to dementia risk amitriptyline , paroxetine, and bupropion (most commonly taken for depression) oxybutynin and tolterodine (taken for an overactive bladder) diphenhydramine (a common antihistamine, as found in Benadryl ).
Options include citalopram ( Celexa ), fluoxetine ( Prozac ), nortriptyline (Pamelor), paroxetine ( Paxil ), and sertraline ( Zoloft ). Side effects of these medicines can include drowsiness, dry mouth, constipation, and anxiety.
Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly prescribed medications with low risk adverse events.
Drugs to Be Used With Caution in Older Adults (Based on the American Geriatrics Society 2015 Beers Criteria Update) Carbamazepine . Carboplatin . Cyclophosphamide. Cisplatin. Mirtazapine. Oxcarbazepine. Serotonin–norepinephrine reuptake inhibitors. Vincristine .
However, elderly patients are more likely to have unwanted effects (eg, severe drowsiness or unsteadiness) and age-related kidney or liver problems, which may require caution and an adjustment in the dose.
Zoloft is the most commonly prescribed antidepressant; nearly 17% of those survey in the 2017 antidepressant use study reported that they had taken this medication. 1 Paxil ( paroxetine ): You might be more likely to have sexual side effects if you choose Paxil over other antidepressants.
The results showed the most acceptable antidepressants were agomelatine , citalopram , escitalopram , fluoxetine , sertraline , and vortioxetine ; least acceptable (ones with the highest dropout rates) were amitriptyline , clomipramine, duloxetine , fluvoxamine, reboxetine, trazodone, and venlafaxine .
On March 5, the Food and Drug Administration (FDA) approved the first truly new medication for major depression in decades. The drug is a nasal spray called esketamine , derived from ketamine —an anesthetic that has made waves for its surprising antidepressant effect.
With the exception of paroxetine, the long-term use of most antidepressants does not increase dementia risk, suggests a study published in the Journal of the American Geriatrics Society.
Short-half-life benzodiazepines, such as oxazepam , alprazolam , and triazolam , are usually recommended for older adults, because these agents do not accumulate in the blood, are rapidly cleared from circulation, and offer greater dosage flexibility.
The recommended maximum tolerated doses of trazodone for elderly patients for the treatment of depression are 300 to 400 mg/day. The pharmacokinetics of trazodone have been shown to be dependent on age, primarily due to decreased oxidative metabolism in older patients.